Enteral Nutrition Practitioner Tutorial - An Online Case-Based Learning Program

描述（由申请人提供）：肠内营养（EN）通过饲管为无法通过口服满足营养需求但仍保留足够消化和吸收功能的个体提供营养。这些患者容易发生EN相关不良事件（例如感染、代谢、胃肠道和营养并发症），可能导致发病率和死亡率增加。尽管如此，研究已经确定了许多医疗，营养和成本效益时，EN使用得当。一份政府报告得出结论，在重症和手术患者中使用早期EN具有改善患者结局的巨大潜力，并且有强有力的证据支持其广泛实施。然而，许多医疗保健从业人员缺乏最新的培训，以最安全和最有效的方式提供EN。在某种程度上，这是因为掌握循证知识和专业技能可能具有挑战性，学习起来也很耗时;全面的跨学科EN培训计划并不广泛。对于第一阶段SBIR提案，Medantic Technology（[MT]，一家医学教育软件公司）将与美国肠外和肠内营养学会（[A.S.P.E.N.]，一个专业的营养学会），以开发一个基于网络的，自我指导的肠内营养从业人员（ENPT）的原型。ENPT将采用多模式远程学习平台中的主动学习原则，使用基于证据的教学演示，交互式患者模拟，临床推理技能的应用和形成性反馈，以增强最终用户的核心能力，以提供EN的最佳实践。第一阶段的工作将提供可行性证明，并为第二阶段开发ENPT产品和研究其教学效果奠定基础。第一阶段项目的具体目标是：1）设计ENPT课程，2）确定关键软件功能，3）准备内容开发计划，4）构建和演示ENPT原型，5）设计第二阶段研究计划。第二阶段ENPT的完成和评估将为医疗从业人员提供急需的培训资源，并实现以下目标：1）促进安全实践，以最大限度地提高潜在获益并减少可预防的EN相关并发症，2）提供研究机会，以确定最有效影响EN相关实践行为的教育方法。通过应用医学和行为研究来帮助减轻国家的疾病负担，这个项目与NIH的使命是一致的。此外，该提案提供了一种创新方法，通过促进安全、有效、以患者为中心、及时、高效和公平的护理，帮助实现医学研究所（IOM）质量鸿沟报告提出的关键医疗保健目标，以满足越来越多的机构和家庭护理环境中需要EN的患者。项目相关性：医学教育的一个基本目标是确保医疗从业者及时地将最佳实践研究纳入常规患者护理中。将开发的产品，肠内营养从业者指南（ENPT），将提供创新的计算机辅助教学（CAI），以促进医疗保健从业者将循证EN研究转化为实践行为和系统范围的协议和指南的能力。Medantic Technology（MT）认为：1）拟议的ENPT最显著的公共卫生影响将是最大限度地发挥EN的潜在益处，同时降低与EN输送相关的可预防不良事件的发生率; 2）在第二阶段进行的研究将证明使用该教程会对实践行为产生有利影响。

DESCRIPTION (provided by applicant): Enteral nutrition (EN) provides nutrients through a feeding tube for individuals who cannot meet their nutrition needs orally, yet retain adequate digestive and absorptive function. These patients are vulnerable to EN-related adverse events (e.g. infectious, metabolic, gastrointestinal, and nutrition complications) that can result in increased morbidity and mortality. Nonetheless, research has identified numerous medical, nutrition, and cost benefits when EN is used appropriately. A government report concluded the use of early EN in critically ill and surgical patients has great potential to improve patient outcomes and there is strong evidence to support its widespread implementation. Yet, many healthcare practitioners lack up-to-date training to deliver EN in the safest and most effective manner. In part, this is because mastery of evidence-based knowledge and specialized skills can be challenging and time consuming to learn; and a comprehensive, interdisciplinary EN training program is not widely available. For this Phase I SBIR proposal, Medantic Technology ([MT], a medical education software company) will collaborate with the American Society for Parenteral and Enteral Nutrition ([A.S.P.E.N.], a professional nutrition society) to develop the prototype of a Web-based, self-directed Enteral Nutrition Practitioner Tutorial (ENPT). ENPT will employ principles of active learning in a multi-modal distance-learning platform using evidence-based didactic presentations, interactive patient simulations, applications of clinical reasoning skills, and formative feedback to enhance end users' core competencies for the best practice delivery of EN. This Phase I effort will provide proof-of-feasibility and lay the foundations for Phase II development of the ENPT product and research of its pedagogical effectiveness. The specific aims of the Phase I project are to 1) design the ENPT curriculum, 2) identify key software features, 3) prepare the content development plan, 4) build and demonstrate the ENPT prototype, and 5) design the Phase II research plans. Completion and evaluation of ENPT in Phase II will provide a much-needed training resource for healthcare practitioners and fulfill the goals of: 1) promoting safe practices to maximize the potential benefits and reduce preventable EN-related complications, and 2) providing a research opportunity to identify educational methods that most effectively influence EN-related practice behaviors. By applying medical and behavioral research to help reduce the nation's burden of illness, this project is consistent with the mission of NIH. Furthermore, this proposal offers an innovative approach to help fulfill the key healthcare aims set forth by the Institute of Medicine's (IOM) Quality Chasm reports by promoting safe, effective, patient-centered, timely, efficient, and equitable care to the increasing number of patients who require EN in institutional and home care settings. Project Relevance: a fundamental objective of medical education is to assure that healthcare practitioners incorporate best practice research into routine patient care in a timely manner. The product to be developed, an Enteral Nutrition Practitioner Tutorial (ENPT), will offer innovative computer-assisted instruction (CAI) to facilitate healthcare practitioners' ability to translate evidence-based EN research into practice behaviors and system-wide protocols and guidelines. Medantic Technology (MT) believes that: 1) the most dramatic public health implications of the proposed ENPT will be to maximize the potential benefits of EN, while reducing the incidence of preventable adverse events associated with the delivery of EN and 2) research conducted in Phase II will demonstrate that use of the tutorial leads to favorable effects on practice behavior.